In the weeks leading up to the completion of my fieldwork in the settlement, I conducted recorded interviews focused on the birth experiences of the women I had become best acquainted with in the course of the previous eleven months (and, in some cases, several years before). Involving birth in the larger field of reproductive decision-making was a logical extension of my research topic, and my original plan had included a brief stint of field research in the maternity ward where the women from the settlement went to give birth. For reasons of both personal and logistical natures, this option was out of reach, and thus I could only ask women to recount their births to me instead of observing what took place when they were in labor.30
Chapter Three is based on birth accounts from the settlement and it moves the reader from the osada to the maternity ward of a larger city in eastern Slovakia where all of my interlocutors who are quoted here gave birth between 1985 to 2010. It is a transition from examining reproduction in everyday life to analyzing reproductive agencies as they appears in medical settings. As in the previous two chapters, this chapter is largely written from the perspective of marginalized Roma, especially women, and it describes the encounters of poor Romani women who give birth with the assistance of non-Roma healthcare professionals. I use narrative discourse analysis to examine personal autonomy, control, and choice in the birthing process experienced by Romani women from a segregated community. Positioning my interlocutors’ narratives against the way the anthropological literature frames agency and decision-making in the obstetric context, I will examine the ways divergent responsibilities coincide and coexist in the face of personal choice and acquiescence to medical expertise.
Here, at the beginning of this chapter, I would like to acknowledge that I neither participated in nor observed these birth experiences directly. I never set foot in the ward my interlocutors describe here, and I did not interview any of the medical professionals they make references to. The perspectives of medical professionals will be addressed in Chapter Four. The chapter is entirely based on recorded interviews with my informants from Veľká Dedinka, most of whom were my close friends, or whom with whom I had developed a confidential relationship with.
The chapter starts with a critical assessment of the natural birth narrative, and a reflection on the extent to which it resonates with women from disadvantaged backgrounds.
30 With the help of a grant from my university (GAUK No.1110116) I managed to conduct two weeks of fieldwork research in a Czech maternity ward popular with Romani women in December 2016. The final two chapters of the dissertation are based on observations made at that research site.
Natural Birth as a Social Responsibility
The issues of control and autonomy, or dominance and resistance, have been at the center of anthropological inquires into birthing for several decades. The idea that women can manage their birth experiences and should strive to give birth without the hegemonic biomedical, increasingly technicized birth model overly intervening in such a life-changing, personal event as childbirth is firmly intertwined with the natural birth movement. One of the leading ideas of natural birth is reclaiming authoritative knowledge (David-Floyd & Sargent, 1997)i from obstetricians and reinstating the birthing female body as the expert in birth giving.
Natural birth advocates emphasize that low (or no)-intervention, midwife-led births allow women to retain a sense of self (MacDonald, 2006, p. 236). Predictably, social scientists question the idea that any birth can be considered fully natural, and both the meaning of the term and the labor experiences bundled under it have shifted over time (MacDonald, 2011 and 2006; Mansfield, 2007).
The past decades have witnessed growing criticism of the romance of nature as the driving force behind birthing and the implicit moral imperatives suggesting that natural births are the most suitable or desired birthing options for all women (Malacrida & Boulton, 2014).
Natural birth is an ideal that not many women can or may want to achieve. Anthropologists researching childbirth have pointed out the peremptory belief that no or low-intervention births are universally empowering and that a women can also gain a sense of control from birth experiences where technological interventions abound (Davis-Floyd, 1994; Akrich & Pasveer, 2004; Carter, 2010; Davis-Floyd, 1994, 2003; Martin, 1992).
Implicit in the discourse on natural birth is the idea of control – the retention of control by the birthing woman and the reclaiming of authority over delivery-related decisions from birth professionals, especially doctors. Layne (2003, p. 188) described this emphasis on autonomy as the ethics of individual control, which is ingrained in a culture of meritocracy. The number and nature of medical interventions are seen as an indicator that assesses women’s ability to control the birthing process and a barometer for the amount of reproductive autonomy women have during delivery. McCable (2016, p. 183) describes the concept of mothercraft as “the shaping of maternal identities to reflect neoliberal ideals of self-sufficiency and individual responsibility” as widely appropriated not only by some women, but also by medical professionals, especially midwives, in contemporary birth culture. Childbirth is portrayed in the logic of mothercraft “as an individualistic journey during which one conquers their fears and emerges transformed” (2016, p. 181) and birth pain, especially if it is unalleviated, serves as a harbinger of the “reward of producing a healthy child” (Carson et al., 2017, p. 822).
In contemporary biomedical contexts, a low-intervention birth is something women must actively work for by making responsible choices before, during, and after birth. These choices include writing up birth plans in which women detail their wishes or preferences during delivery, and equipping themselves with biomedical knowledge. Not “achieving” a no or low- intervention delivery can be seen both by birthing women and their social worlds as a personal failure (Clift-Matthews, 2010), attributable to insufficient cultural capital (in the form of knowledge of health), determination, or willingness to resist medical interventions, and ineptitude in taking full ownership of the birth experience. Engraved in the significance attributed to responding to the range of birthing choices available in contemporary birthing culture and making informed, responsible decisions are neoliberal ideals of choice by subjects who act autonomously and rationally (Lupton & Schmied, 2013, p. 828). The expansion of choices amplifies women’s responsibility for their birth outcomes (McCabe, 2016, p. 178), and, in a healthcare setting, discourses on empowerment and choice not only obscure the needs of poorer people, but also disadvantage them (Anderson, p. 1996). The feminist critique of birthing choices complicates the idea that women should strive for full control of their birth experience (or that such a thing is even possible), yet it also acknowledges that birthing women should have more autonomy in an increasingly technicized biomedical birth model than what they currently exercise (Malacrida & Boulton, 2014, p. 45).
According to Liamputtong (2005, p. 247), women’s self-perception of “risk” influences their willingness to accept or reject medical interventions during childbirth. Similarly to all fields of healthcare, social class membership matters significantly in the individual experience of birth (Williams, 1995, p. 597 cited in Liamputtong 2005, p. 246), even if birth is experienced similarly by women across class and race. There are several understandings of what forces shape the amount of agency that women can and want to have in the birthing process. Miller and Shriver (2012) utilize Pierre Bourdieu’s concept of habitus to gain a clearer perception of women’s birth preferences, but note that the lived experience of birth is molded at a structural level by economic constraints and the availability of birthing options. They assert that women’s childbirth preferences and concurrent decisions depend on which of the three types of habitus – the scientific-medical framework, a lifestyle centered on religion, or the natural family perspective – they subscribe to. Habitus is decisive in women’s understanding of risk, but regardless of the type of habitus, women make childbirth choices which they believe will have the best outcomes both for themselves and their babies.
Birth and pregnancy-related expectations and wishes are the central topic of Emily Martin’s influential book The Woman in the Body (1992). Martin asserts that the need to perform self-control was much stronger among middle class women than among those who are working-class, who were more preoccupied with the lived reality of childbirth, focusing on
the pain and the length of the labor process. Middle class women, however, both in their practices and their communication during childbirth actively sought to resist technological interventions and minimalize medical control. Another influential anthropologist of birth, Ellen Lazarus, came to a similar conclusion when she wrote that middle class women leaned toward sets of choices which enabled them to exert more control over how they give birth, whereas working-class women did not desire or assume to have control and their emphasis was on the continuity of care (1994, p. 25). Researching the birth preferences of Australian middle- and working-class women, Zadoroznyj (1999) also argues that the issue of choice and control was increasingly important for middle class women, and that working class women tended to be more “fatalistic” in the birth process. Working on Lebanese women’s birth choices, Kabakian- Khasholian et al. (2000) found that socio-economic status negatively influences women’s ability to assert their agencies during childbirth. There seems to be a general consensus among feminist social scientists who research birth that poorer women’s lack of ability to meaningfully take responsibility for their deliveries can be attributed to a somewhat non- specific intersection of economic problems and social inequalities.
Building on the body of scholarship above, in this chapter I have three main objectives.
First, I will examine Romani women’s attitudes to childbirth interventions. My data suggests that childbirth is not understood by Romani women in terms of moral regimes, and their focus is on the outcome of the delivery, rather than its performative or transformative potential. My second point is that for the women I conducted research with, autonomy and control are important values in connection with birthing, but in practice they are difficult to attain within the hospital setting. This is not only because Roma actively feel a sense of not-belonging in the maternity ward, but, importantly, because birthing is an arena reserved for gadžo medical expertise in which Roma do not feel empowered to interfere. However, Romani women actively strive for agency imminently before or after birth by delaying hospitalization or leaving the maternity before official discharge. They do not (cannot) envisage a hospital where their bodies would belong to them, and going to the maternity ward late or absconding early are mechanisms for reappropriating control. The last point I want to make in this chapter is that disadvantaged Romani women seek to achieve a feeling of control over the fear of birth, and over the quality of their hospital stay. Since they do not actively compete with or question medical decisions and they do not feel they belong in the gadžo hospital environment, what Romani women are concerned with is being recognized as being equal to non-Roma patients by gadžo staff. Equality for my informants translates to fair access to the material goods and services non-Roma women take for granted.
Tell Me Your Story
I will start the ethnographic part of this chapter by making a number of methodological observations. I scheduled my recorded interviews for the last two weeks of my eleven-month fieldwork period, since the more strongly I bonded with my research participants, the more clearly I understood their potential discomfort with recorded semi-formal interview situations.
Having a recording device with me, however small, and thus formalizing my position as the inquirer was a different setup from our usual interactions. The women (and sometimes men) I talked with kept making references to the presence of my recording device in the room, but they did not behave like disciplined interview subjects. Although my digital recorder equipped me with a sense of mystique, we still interacted jovially. Because I’d already established deep personal connections and a history of friendship with some of my interlocutors which reached back several years, I by no means appear as a disembodied being in my interviews, and I teased, gave unsolicited advice, or argued with my interlocutors just as often as they did with me. Some women took the interviews as an opportunity to share their experience with me as seniors in the field of birthing, since at that time I had no personal experience with it. With some people, I only asked about the birth experience (starting from the contractions, asking “varker mange sar has sar gejľal te lochol” – tell me how it was when you went to give birth), while with others it was an opportunity to put the missing pieces together about their reproductive trajectories or family histories. Some interlocutors intuitively started their narrative with a reference to cohabitation or dating. Other interviews turned into de facto life story interviews.
Overall, I recorded thirteen interviews which dealt with childbirth to some extent.
Although only four out of these are group interviews, all the others were recorded with the participation of many more people than the interviewee, as family members or unannounced friends and acquaintances dropped into the usually one-room houses where we talked. Most of them contributed to the interview with frequent jokes, giggles, and comments. Children were always present, unless their mothers felt that she shouldn’t hear about certain subjects. Initially I felt frustrated that much – if not most – of what was discussed during the interviews was off- topic. All sorts of subjects emerged spontaneously and were debated without delay, and thus my transcripts of what “should have been” birth narratives instead are often about couples or girlfriends discussing their sexual lives, complaining about good-for-nothing husbands, or sharing dinner receipts.
Initially, I made attempts to strongly guide the discussions and remind my interlocutors about the topic of labor and delivery when their interest dwindled or alternated with other matters that they felt warranted discussion. After a while, I accepted that my interviews would be nothing like those in the methods section of a how-to-do-ethnography textbook. Our group
conversations often dissolved into simultaneous chatter between individuals, and I frequently asked myself what other anthropologists would do in a situation like this. I measured myself against the ideal ethnographer, as did John Law (1994, p. 43) when he researched a laboratory setting, thinking that others would make better choices of words, lead the conversation more solemnly, or stick to a more firmly set list of questions. Abandoning this ideal was – still is – a process, but the fact that I had to go with the flow was a decision made as much by my interlocutors as by myself. Perhaps this is also a form of collaborative ethnography (Lassiter, 2005), or maybe it was just a lesson on my own preconceptions of control while I was researching the issue of control. In any case, in one group interview the topic of childbirth came up only one and a half hours after I pushed the recording button: we discussed fussy children, made phone calls, welcomed guests, and debated the daily news and osada gossip first.
Crying children, background noise from the perpetually running TV or other devices, and frequent disruptions due to my interlocutors’ constant availability to fulfill the needs and obligations of their kin in the home environment meant that few of the topics we explored were pursued in as much detail as I would have wished to. Occasionally, the recordings were hard to decipher and I often experienced ”researcher‘s guilt” (Mamali, 2019). Sometimes, I pressed for interviews even in moments where my interlocutors were obviously busy doing household chores or taking care of their children, knowing that a more relaxed moment or opportunity to have a recorded discussion may not come at all.
It didn’t help my feelings of methodological failure that after obtaining their verbal consent for recording and explaining that the interviews will be used for my dissertation (which I phrased as the book I was writing for my school so that I can finish my studies), an alarming number of my interlocutors, including those who had become my close friends, expressed genuine surprise and uneasiness about the fact that I would write about their lives.31 In moments like this, sometimes other interlocutors would come to my rescue, explaining to the person who shared their concern that my writing will be anonymous and that their identity will not be traceable. Permission to record was never denied and at times my interlocutors came up with a solution themselves: Daisy [Sedmikráska], for example, was not concerned about the recording itself, but about the fact that I planned to store (at least for a while) the file in my laptop, which I sometimes carried in the field to show the photos I had taken. Daisy worried that people [o Roma] would get ahold of my laptop and listen to her narrative account. In the end, she winked at me and said on the record that she was telling me the story of another
31 I will assert here again, as I did in the previous chapters, that I do not think that most of my informants fully understood how my long-term presence in the settlement amounted to empirical research. This was similar, however, to the attitudes my family or some friends had, who also expressed skepticism both about the ethnographic method and my field site choice (see Chapter 1).
woman with whom she had shared a room at the maternity ward. Framing her story as another woman’s story made her feel less vulnerable.
Narratives of Childbirth: Wrangling the Genre
In narratives of childbirth, but by extension in any narrative analysis, one concern is the lapse of time between the recounted event taking place and when the event is told, and another issue is that narrative accounts of lived events are situated narrative perspectives. My analysis in this chapter is based on maternal memory narratives and I made no attempts to fact-check the stories which were presented to me. Already during the interviews, it was apparent that the stories women presented about individual birth experiences were frequently contradictory. I usually made attempts to clear up inconsistencies during our interaction, but this was not always possible, nor always welcome. But should narratives express actual lived experience, or interpretations of experiences (Carter, 2010, p. 998)? Having had up to eight births, many women may simply did not have had vivid memories of each labor experience. In other cases, an interlocutor recounted the same birth story to me several times during the interview, each time rewriting the scene with her words in a way that positioned her as a more authoritative agent in her interaction with medical professionals. Instead of putting the truth content of such narratives into question, I found such reframing analytically valuable. Maternal memory is compelling in that can grant women the opportunity to retrospectively reassert their agencies in past events marked by loss of autonomy, thus effectively repositioning their involvement in these events as active social selves (Oakley, 2016, p. 533).
Within the genre of childbirth narratives, first-hand, retrospective accounts of labor are often used to gain insights about women’s bodies as politicized subject in an increasingly medicalized birth culture. But much of the literature I rely on in this chapter includes interview quotations which are elaborate and highly reflective of birthing women’s intentions, wishes and expectations. This was not characteristic for the type of language I encountered among the women of Veľká Dedinka. Most of the narratives I collected there were far from embellished accounts and I struggled to epistemologically make sense of them. This was especially true for uncomplicated deliveries when the birth story was recounted in two to three simple sentences. Petra’s narrative is a typical example:
Edit: Tell me about your birth experience.
Petra: It was good. It was nothing! I had good births. [Lačhes! Ta nič! Lačhe porody man has.]